The language we use conveys our attitudes about ourselves and others. More specifically, the words we use portray how we as a society and individuals perceive different groups. In the addictions field, language has a major impact on how we view and treat those affected by specific addictions.
Addictions language allows us to mentally retrieve schemata—cognitive configurations with specific criteria organized in templates.
Schemata afford us cognitive shortcuts by quickly identifying people who are labelled. For instance, we have a specific schema when we think of the word “junkie.” That particular word evokes preconceived notions and ideas such as a hopeless addict who is severely addicted to narcotics and evades social and economic responsibilities.
Thus, those labeled as “junkies” are placed into the specific schema—even though they may not exactly fit the label.
More precisely, in the alcohol use disorder (AUD) sub-field, some of the dialect used is sometimes harsh, unforgiving and stigmatizing. This particularly stigmatizing dialect can counteract treatment efforts and perpetuate risky behavior by those labelled as living with AUD.
Reforming the Dialect
By mutual intelligibility, I mean that both sides lack clarity and understanding. There are misunderstandings across the dialect continuum between polar ends. To illustrate, I briefly examine the terms alcohol abuse, alcoholic and clean.
To begin, alcohol abuse is a sharp, piercing term that screams the word “criminal” and conjures up elements of criminality such as reformation and punishment. If we just analyze the word “abuse,” it has very negative connotations.
Our conceptualization of abuse—in its Western context—is one of an overarching, umbrella term that incorporates serious vices such as child abuse, marital abuse and sexual abuse among many others.
In regards to AUD, it is argued that people are abusing themselves by hurting and neglecting their social, physical, and psychological well-being. However, that catapults people with problematic drinking patterns into a category with criminal offenders.
When you are labelled as abusing alcohol, you are scrutinized under the criminal lens. Directly or indirectly labelling people as criminals stigmatizes them and can disempower them, further diminishing rehabilitative efforts.
Instead of focusing on a misdirecting and disenfranchising term such as alcohol abuse, I suggest society turn towards terms which could incorporate words such as problem, unsafe, hazardous, dangerous, and risky in describing abnormal and excessive alcohol usage.
These are terms that do not necessarily undermine the severity of problematic drinking, but instead may work towards lessening or possibly eroding the stigma.
Secondly, when we call or label someone an alcoholic, we are not simply associating them with problematic drinking that causes significant harm and distress in their life; but, we are effectively giving people an identity.
In the context of the word alcoholic, the AUD is centralized in that it becomes the focal point to which all, if not, most aspects of one’s life converge. Reciprocally, alcoholism fixates itself as a central point of radiation—influencing and dictating one’s activities.
One is largely defined and identified by their alcohol use—mitigating other special qualities or more positive personality traits and personal accomplishments. Attaching an alcoholic identity to people can be lethal as it can reinforce people’s behavior through a self-fulfilling prophecy.
Ascribing and branding people as alcoholics can directly or indirectly result in people incorporating an alcoholic identity through a cognitively and behaviorally reinforced feedback cycle. Those labeled begin to think of themselves as alcoholics and reinforce those cognitive processes through the continuation or increase of alcohol-related behaviors and activities.
Instead of referring to people as alcoholics, which morphs their personal identity and alcoholic identity—perhaps we could refer to them as people with AUD. The simple preposition “with” helps decentralize and may even derail the alcoholic identity by separating the person from the disease. Therefore, people still maintain their personal identity and are also identified as living with AUD as opposed to any pre-existing identity being consumed by an alcoholic identity.
Lastly, when we refer to people with AUD as clean, we are saying they have achieved sobriety—at least for the time being.
People who are now clean were once dependent on alcohol. If someone is now clean, then it is logical that they were “dirty.”
In the context of AUD, they were infected or infested with disease—an agent that affected their physical and/or psychological well-being. From a moral standpoint, they were impure and sinful.
That contrast between cleanliness and impurity can reflect negatively on one’s personal and moral character.
According to society, someone who is clean was once morally impure, and by society’s standards, was unable to control their problematic drinking. Someone who is clean was once showing a lack of moral restraint and excess moral weakness in controlling their indulgences.
Someone who is clean could potentially relapse—no matter the amount of time lapsed. Thus, when they do go dirty, they have to work on cleaning themselves up again. Over many years, AUD has evolved from a condition of moral weakness to a chronic disease involving biopsychosocial influences. The clean/dirty dichotomy only propels us backwards into the grasp of the morality paradigm of AUD, which emphasized blaming the problematic drinker.
The goal of critically and closely analyzing the language is to learn or realize how language can perpetuate AUD instead of treating it.
Professionals, clinicians, and lay people must work to empower people to seek help. People seek help when they feel comfortable and empowered. In order for people to get help, they must not be afraid of ridicule, exclusion, shame, and guilt.
Unfortunately some of the language is stigmatizing. It sets up a you-versus-us climate where those affected by AUD are socioeconomically excluded. On the dialectic continuum, there are clearly misunderstandings between the “us” end and the “you/them” end.
I am not proposing sudden elimination of all stigmatizing terms, but am championing a sort of dialect abeyance—a suspension of AUD discourse into a dialogical state and space where there is a transdisciplinary examination and exchange of ideas.
It means the scientific community, political leaders, social agencies, non-government organizations, businesses, and the public must have several co-existing dialogues about how we frame AUD language in order to perpetuate a climate of trust where people are comfortable seeking help. Then perhaps, we may move closer towards fostering an environment of mutual intelligibility with increased clarity and understanding.